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01/08/2018

CGS Clarifies Coverage of Bilateral Cataract Surgery

After hearing from several members, the OOS reached out to the our Medicare Contractor, CGS, to clarify coverage for bilateral cataract surgery. Below is the clarification we received from the medical director.

Bilateral cataract extraction performed on both eyes, on the same date of service is termed immediate sequential bilateral cataract surgery (ISBCS). ISBCS as an approach to bilateral cataract extraction may afford certain clinical benefits but carries with it, the possibility of bilateral visual loss. The decision to perform ISBCS should be an individual decision, made jointly by the patient and physician. The medical record must document the rationale for ISBCS and that the patient has been apprised of the risks and benefits of both this approach and of the available alternatives.

If the first cataract extraction is performed and a subsequent contralateral cataract extraction is considered, the criteria for coverage of the procedure in the contralateral eye are the same as the criteria for the first cataract extraction.